Efficacy and Safety Profile of Integrase Strand Transfer Inhibitors (InSTIs) for treatment of HIV in Pregnant Women: Systematic Review and Meta-Analysis
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Date
2020-07
Authors
Journal Title
Journal ISSN
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Publisher
Addis Abeba University
Abstract
Background: Integrase strand transfer inhibitors (InSTIs) are the most recent class of drugs
approved on the basis of their efficacy and safety profiles (16). Dolutegravir and elvitegravir are
considered US Food and Drug Administration pregnancy category B; while raltegravir belongs
to category C.
Objective: To assess the efficacy and safety profile of Integrase Strand Transfer Inhibitors drugs
for treatment of HIV in Pregnant Women
Method: Literature search strategies were done using medical subject headings (MeSH) and text
words related to InSTIs drugs and pregnancy. Pubmed, EMBASE, Web of Science, Science
Direct, Henari, and the Cochrane Central Register of Controlled Trials and other databases were
searched. The estimated effect (Relative Risks) and associated 95% confidence intervals for the
reduction of HIV RNA viral load were meta-analyzed using a DerSimonian– Laird randomeffects
model
(25).
Statistical
analysis
was
performed
using
RevMan
5.3 software.
Result: Based on our systematic review and meta-analyses data, treatment with InSTIs based
ART regimens showed to be more beneficial for HIV positive pregnant women compared to
other currently used treatment strategies. Both preterm delivery and proportion of infants with
Small for Gestational Age didn’t show statistically significant association with the use of InSTIs
(risk ratio 0.82, 95% CI 0.60–1.13, I
2
=0%) and (risk ratio 0.90, 95% CI 0.58–1.40, I
=0%)
respectively. DTG based ART showed a lowered maternal serious adverse event compared to
current treatment regimen (risk ratio 1.94, 95% CI 1.13–3.32, I
2
=0%).
Conclusion: We suggest use of DTG based ART regimen to be preferred first line choice for
HIV positive pregnant women, if the pregnancy is confirmed already past 8 weeks of gestation.
Although further investigation is necessary about safety data, we suggest InSTI drugs, especially
RAL, can be safely used during pregnancy particularly in late presenter pregnant women or as an
intensification strategy. Because of the short and long-term consequences of adverse events seen
in infants, particularly preterm birth and SGA, future studies need to assess the safety profile of
DTG for infants and explore potential mechanisms of adverse outcomes.
2
Description
Keywords
InSTIs, pregnant women, viral load, efficacy and safety